Provider Demographics
NPI:1336655570
Name:VITUCCI, LETICIA (LMHC, CASAC, NCC)
Entity Type:Individual
Prefix:MS
First Name:LETICIA
Middle Name:
Last Name:VITUCCI
Suffix:
Gender:F
Credentials:LMHC, CASAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-0200
Mailing Address - Country:US
Mailing Address - Phone:631-433-4497
Mailing Address - Fax:
Practice Address - Street 1:395 N SERVICE RD STE 302
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3142
Practice Address - Country:US
Practice Address - Phone:631-433-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006395101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor